The worsening of ED on-call coverage in California: 6-year trend

Area of Science:

• Health Services Research
• Medical Economics
• Public Health Policy

Background:

• Physician on-call coverage is crucial for emergency department (ED) patient care.
• Previous studies indicated challenges in specialist availability for ED consultations.
• The impact of insurance status on on-call physician responsiveness requires ongoing assessment.

Purpose of the Study:

• To reassess the state of on-call physician coverage in California EDs.
• To evaluate changes in specialist availability and responsiveness since 2000.
• To investigate the influence of patient insurance status on ED care.

Main Methods:

• Anonymous survey repeated from 2000, distributed to the California chapter of the American College of Emergency Physicians.
• Physician respondents represented 77.4% of California EDs, 51.0% of ED directors, and 34% of surveyed physicians.
• Data collected on on-call availability, medical staff rules, specialist payments, and perceived impact of insurance status.

Main Results:

• On-call availability worsened for 9 of 21 specialties since 2000.
• Fewer ED directors reported mandatory on-call duty (54% vs. 72% in 2000).
• 80.3% of emergency physicians reported insurance status negatively affects on-call responsiveness, a significant increase from 42% in 2000.
• EDs serving predominantly minority or uninsured patients had fewer specialists and greater access difficulties.
• Insurance status significantly impacts ED consultation and follow-up care.

Conclusions:

• The on-call physician coverage situation in California has substantially worsened over a 6-year period.
• Patient insurance status is a major determinant of specialist availability and responsiveness in EDs.
• Targeted interventions are needed to address disparities in on-call coverage, particularly for vulnerable populations.